- What can right arm pain indicate and how to treat
- Could GERD Cause Arm Pain?
- Heartburn vs. heart attack
- Avoiding clots
- Preventing bleeding
- Clopidogrel concern?
- Chest pains during pregnancy: What to know
- When to Call 911
- Heartburn or Heart Attack? How to Tell the Difference
- Hiatal Hernia: An Overlooked Cause of Disease
- Gastroesophageal Reflux Disease
- Characteristics/Clinical Presentation
- Associated Co-morbidities
- Diagnostic Tests/Lab Tests/Lab Values
- Systemic Involvement
- Medical Management
- Physical Therapy Management
- Lifestyle Changes
- Differential Diagnosis
- Case Reports/ Case Studies
What can right arm pain indicate and how to treat
Pain in the right arm can arise due to a variety of causes, with the most common being strokes or injuries to the arm’s structures, such as having poor posture, repetitive strain or sleeping over the arm, for example.
Arm pain can occur in any region, from the shoulder to the wrist, usually by affecting areas such as the muscles, tendons, nerves, joints, blood vessels, and skin. Only in rare cases can it indicate a more serious problem, such as a neurological disease or even a heart attack.
So, to identify the exact cause of the pain, it is necessary to seek medical attention. The doctor will do an evaluation of the symptoms, physical examination of the region and, if necessary, request tests to determine the cause and indicate the most correct treatment.
The are many causes for right arm pain, but you can find the main ones below:
Intense arm exercises, common in people who go to the gym or play sports, may cause minor injuries to the muscles of the arm or joints of the shoulder, elbow, or wrist, which causes pain that usually improves after a few days of rest.
When effort is repetitive, especially in people who work with arm movements, such as teachers who write on the board, machine workers, musicians or athletes, it is possible to have Work-Related Musculoskeletal Disorder (DORT), also known as Repetitive Stress (RSI).
What to do: In order to prevent this type of injury, it is necessary to obtain advice from the doctor and physiotherapist on the correct postures that must be taken during the movements, to avoid wearing the arms structures and, at the moment of acute pain, the doctor may indicate anti-inflammatory medication and rest.
Tendonitis is an inflammation of the tendon, a tissue that connects the muscle to the bone, which generates symptoms such as localized pain and lack of muscle strength. It can arise more easily in people who make repetitive movements with the shoulder or arm, or in a sportsmen.
What to do: To treat tendonitis it is recommended you avoid making any type of exertion with the affected limb, taking painkiller or anti-inflammatory drugs indicated by the doctor, and performing the physiotherapy sessions.
3. Carpal Tunnel Syndrome
Carpal tunnel syndrome occurs due to nerve compression that extends from the arm to the hand, called the median nerve. This syndrome is characterized by the appearance of tingling and a sensation of needles mainly on the thumb, index finger or middle finger.
Carpal tunnel syndrome is more common in professionals working with the hands and wrists, such as typists, hairdressers or programmers, for example, and the symptoms appear gradually, and may even become disabling.
What to do: The treatment is guided by the orthopedist or rheumatologist and includes the use of anti-inflammatory drugs, rest and physical therapy.
4. Poor circulation
Changes in the arms blood circulation, caused by an obstruction in the blood vessel or a thrombosis in veins or arteries, for example, can cause a pain or tingling sensation, weight and swelling of the affected limb.
Poor circulation should be suspected when the extremities of the hands are very pale or purplish, swelling in the arm or hands or tingling sensation.
What to do: It is necessary to see a general practitioner or angiologist, who will make a detailed evaluation and will ask for examinations like Doppler ultrasound of the arm. Treatment depends on the cause, and may involve fluid intake, exercise or, in more severe cases, the use of medication to facilitate circulation.
5. Heart attack
Acute myocardial infarction or angina can cause chest pain radiating to the arm, and although it is more common in the left arm, it may radiate to the right arm. This symptom of infarction is rare, but it can occur primarily in the elderly, diabetics or women, who may present atypical symptoms more often.
Arm pain that indicates a heart attack is usually associated with a burning or tightening sensation, chest pain, shortness of breath, nausea, or sweating.
What to do: If a heart attack is suspected, it is recommended to go to the emergency room so that the doctor can evaluate the symptoms and ask for tests, which may or may not confirm the problem.
Could GERD Cause Arm Pain?
Q1. Would you get arm pain with an attack of GERD?
— Mary, Michigan
Arm pain is not a common symptom of GERD (gastroesophageal reflux disease), although it can occur in rare cases. In general, GERD involves the reflux of stomach contents into the esophagus. While many patients have no symptoms, heartburn is the most common complaint. However, other patients have more atypical symptoms such as chest pain, which can mimic heart attack; and sore throat, hoarseness, or a bad taste should stomach contents reach the mouth.
GERD causes inflammation within the esophagus and does not directly irritate the diaphragm or the phrenic nerve that innervates (stimulates) it. Paraesophageal hernias, where part of the stomach is squeezed up into the chest beside the esophagus, may potentially lead to pain.) In terms of arm pain, here’s the likely scenario: Sometimes the contents of your stomach make their way into the trachea (or windpipe, which runs next to the esophagus), and then reach the lungs, causing exacerbations of asthma and occasionally pneumonitis or infectious pneumonia. Should that occur, the diaphragm (the big muscle under your lungs that helps you breathe) may become inflamed. Since the diaphragm is innervated by the phrenic nerve, which starts near the cervical spine, regions that are also served by spinal nerves can be affected, e.g., the arms and shoulders.
Keep in mind that left arm pain is often associated with heart disease, so if you haven’t yet been evaluated for your pain, you should see a physician soon.
Q2. My 8-year-old daughter has been complaining of nausea for about a month now. It began while she was eating some candy at the movies when she suddenly didn’t feel so well. Our family doctor said not to worry, but her symptoms have steadily progressed. She complains of heartburn about twice a week and says she’s nauseated after eating in the morning. She also has developed a rash on her chest and back. Any advice?
It is difficult for me to diagnose your daughter without examining her and getting more detailed information about her symptoms. However, there are several common causes of prolonged nausea in children. You mentioned one common cause — heartburn, also known as “gastroesophageal reflex disease,” or GERD. Patients with GERD experience an uncomfortable sensation when acidic contents from the stomach reflux backwards up into the esophagus. Symptoms of reflux include pain in the middle of the abdomen or chest, nausea, and sometimes even a bad taste in the mouth after eating. This is a very common problem that is often treated with diet modifications such as eating fewer fatty foods, eating smaller meals, and not lying down after eating. Medications which lessen the acidity of the contents in the stomach are often used to treat symptoms. There are a variety of medications available ranging from Tums and Maalox, to Pepcid and Nexium.
Another possible cause of prolonged nausea is inflammation of the stomach, called gastritis. The source of inflammation varies. Sometimes after a viral infection people will develop gastritis that can last anywhere from a week to a couple of months. Some people who experience gastritis are infected with Helicopylori, a bacteria that can cause gastritis, and other problems including ulcers.
There are other causes of prolonged nausea that are not related to the stomach or the gastrointestinal system at all, such as stress. Children quite often report nausea and stomach pain when they are stressed. For instance, children who become stressed about school will experience nausea in the morning, but will feel better in the evenings and on vacation.
As I noted initially, I would certainly need more information to diagnose your daughter. However, in light of her symptoms worsening and her developing a rash, I can recommend that your daughter return to her doctor and have her nausea investigated further. Your daughter may even need to see a doctor who specializes in gastrointestinal issues. Good luck!
Heartburn vs. heart attack
GERD and heart disease are both common, and many people take medications to prevent or treat both conditions.
Heartburn or heart attack?
The symptoms of heartburn may mimic those of angina or a heart attack (or vice versa). If you’re uncertain, don’t hesitate to get to an emergency room for an evaluation as soon as possible.
Angina or heart attack
Tightness, pressure, squeezing, stabbing, or dull pain, most often in the center of the chest
Pain that spreads to the shoulders, neck, or arms
Irregular or rapid heartbeat
Cold sweat or clammy skin
Lightheadedness, weakness, or dizziness
Shortness of breath
Nausea, indigestion, and sometimes vomiting
The appearance of symptoms with physical exertion or extreme stress
Burning chest pain that begins at the breastbone
Pain that moves up toward your throat but doesn’t typically radiate to your shoulders, neck, or arms
Sensation that food is coming back into your mouth
Bitter or acidic taste at the back of your throat
Pain that worsens when you lie down or bend over
The appearance of symptoms after a large or spicy meal
Many people take daily, low-dose aspirin to prevent heart attacks, which works by discouraging the formation of blood clots. Doctors prescribe clopidogrel (a more potent clot-preventing drug) with aspirin, mainly for people who receive stents, the tiny metal mesh tubes placed in clogged blood vessels to improve blood flow. But there’s a downside. “Aspirin can increase the risk of bleeding from the stomach and the intestines, both by directly irritating the stomach lining and by making existing areas of irritation more prone to bleeding,” says Dr. O’Donoghue. Taking clopidogrel with aspirin can further increase that risk.
People with heartburn often take proton-pump inhibitors (PPIs). They include over-the-counter drugs such as omeprazole (Prilosec) and prescription drugs such as pantoprazole (Protonix). These drugs reduce the release of acid from the stomach lining. In addition to causing heartburn, excess stomach acid can also cause bleeding sores (ulcers) in the stomach; these, too, are treated with PPIs, among other drugs.
Thanks to these stomach-protecting effects, doctors sometimes prescribe PPIs for people who take drugs that increase the risk of bleeding — even if they don’t have heartburn.
“I usually recommend PPIs for people who are taking long-term aspirin or clopidogrel if they have ever had a bleeding stomach ulcer or are at high risk of developing one,” says Dr. O’Donoghue. Factors that can boost your odds include an infection with Helicobacter pylori bacteria and routine use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, others) and naproxen sodium (Aleve, Anaprox, others).
Some research suggests a possible problem with taking both a PPI and clopidogrel. Two popular PPIs, omeprazole and esomeprazole (Nexium), inhibit a liver enzyme that helps convert clopidogrel to its active form. In theory, this could make clopidogrel less effective for heart attacks and stroke prevention. But large clinical studies have not revealed any meaningful differences. Still, anyone with lingering concerns about a possible interaction could take a different PPI, such as pantoprazole, which does not affect the liver enzyme.
Image: © Image Source/Getty Images
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Chest pains during pregnancy: What to know
The cause of chest pain during pregnancy may be a severe health issue, such as preeclampsia, a heart attack, or another heart condition.
Chest and shoulder pain during pregnancy can indicate a serious complication called preeclampsia. This can sometimes be fatal for the mother and fetus.
Common signs and symptoms of preeclampsia include:
- high blood pressure
- a persistent headache
- heartburn that does not resolve with lifestyle changes or antacid medication
- pain in the upper abdomen, on the right side, or under the ribs
- swelling in the hands and face
- sudden weight gain
- visual disturbances
- protein in the urine
Preeclampsia typically goes away once the baby is born. However, in some women, preeclampsia continues after pregnancy or begins after they have given birth.
Women with preeclampsia may also experience related complications, such as eclampsia or a syndrome that involves rupturing of red blood cells, a low platelet count, and elevated liver enzymes — commonly called HELLP syndrome.
A woman may not know that she has preeclampsia or related complications. Regular health checks and tests help doctors identify these issues.
Heart disease or heart attack
A relatively uncommon cause of chest pain during pregnancy is a heart attack.
During pregnancy the volume of blood in the body increases to accommodate the growing fetus. In order to pump the extra blood efficiently, the woman’s heart rate increases, and this added strain leads to a higher risk of a heart attack.
A 2018 study investigated the incidence of heart attacks among women in the United States who stayed in the hospital for complications of pregnancy or the adjustment period afterward. Heart attacks had occurred in 8.1 out of every 100,000 of these women.
Women who have heart disease or other preexisting cardiac conditions have an increased risk of a heart attack during pregnancy.
The following symptoms can indicate heart disease:
- chest pain
- a fast heartbeat
- a chronic cough
- extreme breathing difficulties
- extreme fatigue
- extreme swelling or weight gain
A pregnant woman who experiences any of the above symptoms should see a doctor immediately.
When to Call 911
If you have pain in your chest that’s not going away and you’re not sure whether it’s heartburn or a heart attack, call 911.
But don’t forget, the symptoms of heart attack and heartburn can sometimes go away after a while. So always call your doctor if you had pain in your chest and you’re not sure why — even if it stopped.
Also, call 911 if you have symptoms that are more typical of a heart attack or angina (severe chest pain from heart problems), such as:
- Feeling of fullness, tightness, or dull pressure or pain generally in the center of your chest
- Feeling like a belt is being tightened around your chest
- Pain that comes on with exercise, and is relieved by rest
- Sudden chest pain or pressure that gets worse
- Dizziness or lightheadedness
- Pain that spreads to your shoulders, neck, jaw, or arms
- Pain that gets better quickly after taking nitroglycerin
- Shortness of breath
- Cold sweat along with other symptoms
If you have any pain that lasts for more than a few minutes or any warning signs of a heart attack, get medical help right away. Also get emergency help if you’re confused at all about whether your symptoms are from a heartburn or a heart attack.
Heartburn or Heart Attack? How to Tell the Difference
Three years ago, Lee Ann Williamson began feeling uncomfortable as she was playing the piano for the Sunday services at a church in a Kansas City suburb. She wasn’t sure what it was—a heart problem, heartburn, or something else. All she knew was that it felt a bit like someone was sitting on her chest. She tried to ignore the chest pain and kept on playing.
However, as the morning progressed, the pain didn’t go away and indeed got worse. Finally, the then-46-year-old sought out a physician who was a church member, who recommended she go straight to the emergency room.
RELATED: 13 Foods That Fight Acid Reflux
At the hospital, her blood pressure was a very elevated 186 over 110 and she was given nitroglycerin, a drug that relaxes blood vessels and can often help restore blood flow to the heart in heart attack patients. The medication gave her a whopping headache, a common side effect of the drug. Then the ER staff told her that she was not, in fact, having a heart attack. Further testing showed that Williamson was suffering from acid reflux and had inflammation in her esophagus—a sign of gastroesophageal reflux disease, or GERD.
Williamson’s experience is not an uncommon one; chest pain can turn out to be a heart attack or a less serious condition, such as heartburn—but it can be really tough to tell the difference. However, the symptoms do differ. The more you know, the easier it is to avoid heart damage if chest pain does turn out to be a heart attack or unnecessary panic if it doesn’t.
RELATED: 6 Great Pillows for People With Acid Reflux
Brain can mix-up pain signals from chest, stomach
GERD and other gastrointestinal problems such as ulcers, muscle spasms in the esophagus, a gallbladder attack, and pancreatitis can all cause chest pain and other symptoms that mimic those of a heart attack or angina, a crushing type of chest pain caused by decreased blood flow to the heart. Some people with angina say it feels like an elephant is sitting on their chest.
About 300,000 new cases of noncardiac chest pain are diagnosed annually in the United States, according to the Mayo Clinic. Studies have shown that anywhere between 22% and 66% of patients with noncardiac chest pain have GERD, which is caused by chronic acid reflux from the stomach into the esophagus.
The ambiguity in symptoms is caused by the fact that the nerves in the stomach and heart don’t clearly signal to the brain where pain originates.
RELATED: 9 Things That Could Be Giving You Acid Reflux
Nerves in the chest are not as specific as nerves in, say, the hand, says Stephen Kopecky, MD, a cardiologist at the Mayo Clinic in Rochester, Minn. Dr. Kopecky says if someone were to get hit with a hammer on their little finger, the person would be able to identify which finger was injured. But if someone were hurt in the heart, lungs, pancreas, esophagus, or stomach, in each case they may just feel pain coming from the chest.
“This makes for a real problem when diagnosing,” he says. “And about half of patients who have a heart attack have minor symptoms (or no symptoms) and do not seek medical attention.”
Although every individual may experience varying symptoms depending on their stomach or heart condition, there are some ways to differentiate between the two.
RELATED: What Is Alkaline Water, and Can It Really Help With Heartburn?
Other risk factors, timing of pain are key
If the problem is heart-related, you will likely feel a tightness, burning, or pressure in your chest. This pain is often exacerbated by exercise or severe emotional stress. It may spread to the back, neck, jaw, or arms, and is often associated with sweating, dizziness, nausea, difficulty breathing, or an irregular pulse.
The culprit is also more likely to be heart-related if you have risk factors including diabetes, smoking, obesity, high cholesterol, or a family history of heart disease. Age plays a role as well: Heart disease is more common in men over 45 and in women over 55.
Duration is another factor, says Myrna Alexander Nickens, MD, a cardiologist at Jackson Cardiology Associates in Jackson, Miss. She says angina will usually last five to 10 minutes before subsiding, a heart attack with be slightly longer, and reflux can last for hours.
RELATED: 11 Surprising Symptoms of Acid Reflux
If the problem is related to the digestive system, like GERD, it is often a sharper pain that may be precipitated by eating a fatty or spicy meal and is affected by change in position. (It will get worse when lying down or bending over). Stomach acid may come up into your esophagus and can leave a sour taste in your mouth.
But physicians caution that there are always exceptions to any of these rules of thumb. Julius M. Gardin, MD, chairman of the department of internal medicine at Hackensack University Medical Center in Hackensack, N.J., says some patients get angina after eating a big meal because blood flow is diverted from the heart for digestion. And, due to the placebo effect, people who are having a heart attack and mistakenly believe they are experiencing heartburn may actually feel better after taking an antacid, says Dr. Gardin.
Women and elderly people are more likely than younger men to have unusual heart attack symptoms, Dr. Alexander Nickens says. Women may have nausea, exhaustion, and a generalized tired feeling when they’re having a heart attack. Elderly people may feel faint, out of breath, or just generally bad.
RELATED: 7 Home Remedies for Heartburn
When in doubt, get it checked out
If you have symptoms that you are unsure about, see a physician. And go to the emergency room if you have chest tightness, break into a sweat, turn pale, become very weak, or faint.
If you have chest discomfort that’s mild or passes when you’re at rest, an emergency visit may not be necessary, but Dr. Alexander Nickens recommends seeing a doctor as soon as possible. A physician can use a blood test to see if you’ve had a mild heart attack or other heart problems.
She also recommends annual checkups for anyone with heart disease risk factors even if they aren’t having any chest pain or discomfort, and more frequent visits for those with specific risk factors such as diabetes and hypertension, which is particularly likely to increase the risk of heart attack.
RELATED: Heartburn? 7 Medications That Can Help
If you have chest pain that seems to be stomach-related, antacids should improve symptoms. And taking an aspirin, which is a blood thinner, may bring relief for those suffering from heart problems and decrease the chance of having a heart attack or death, Dr. Alexander Nickens says.
If you experience severe chest pain and you aren’t sure what’s causing it, Gardin recommends chewing an aspirin and seeking medical care. (An important exception, he says, is people who have a known history of ulcers, since aspirin can make ulcers bleed.) Although aspirin can make gastrointestinal symptoms worse, it’s the lesser of two evils. “There is a risk-benefit calculation that one would make,” says Dr. Gardin. “The theory is that more people die of heart attacks than reflux.”
If a heart attack is treated promptly—within 90 minutes of when symptoms start—the damage to heart muscle may be minimized. “In terms of a heart attack, time is muscle,” Dr. Gardin says.
To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter
Hiatal Hernia: An Overlooked Cause of Disease
By Dr Cliff Fruithandler DC
Hiatal Hernia has been one of my favourite conditions to treat. One of my first patients 1n 1980, while working as a student Intern came in with Chronic constant belching and epigastric pain. Using my newly acquired knowledge in AK
I found a classic weakness of the diaphragm and psoas muscles. Using Applied Kinesiology Chapman’s and neurolymphatic reflexes along with Chiropractic and simple exercises her symptoms of many years duration, fully resolved with in a few weeks.
Hiatal Hernia is a great mimicker of Heart Attacks (MI) and other issues in the abdominal, chest and thoracic spine regions. Essentially there is a weakness in the diaphragm’s opening (hiatus) for the oesophagus to go through. Pressure on or in the abdomen pushes the stomach up through the hiatus creating weakening of the Cardiac sphincter which then released hydrochloric acid from the stomach into the esopahagus (acid reflux). Its all to common. Treated medically with antacids gives temporary relief, but long term the antacids reduce the digestive tracts ability to breakdown proteins resulting in new digestive issues. We use AK reflexes to diagnose and treat the cause, usually a weakness of the diaphragm and psoas muscles. Finishing with home treatments of the reflexes and exercises the symptoms usually resolve till next Thanksgiving when a huge meal may recreate the weakness. Good news, the home treatment usually puts HH back into check. If not a few office visits with AK and Chiropractic will re clear the flare up.
Below are some excellent articles that go along and fairly well explain my treatment program along with some home self help.
Hiatal Hernia reflexes
Hiatal Hernia: An Overlooked Cause of Disease
Steven H. Horne 1997-2001
About three years ago Jack Richardson, a naturopathic physician, corrected a health problem I must have carried since childhood–a hiatal hernia. The impact this simple maneuver has had on my health has amazed me. I immediately noticed a difference in my lung capacity and my digestion and in the months that followed I began to put some muscle on my skin and bones frame and gain newfound strength and stamina.
Dr. Richardson tells me that this is a common health problem and my own observations as well as those of others confirm this fact. But this is more than a personal observation as the American Digestive Disease Society has estimated that nearly half of all adults–some 60 million people–have a hiatal hernia.
It occurs more often in women than in men. It affects people of all ages, but is most prevalent in people over 50 and highly likely in people over 65.
The Great Mimic
Hiatal Hernia has been called the “great mimic” because it mimics many disorders. A person with this problem can get such severe pains in their chest that they think they are having a heart attack. They may think they have an over acid stomach because they will regurgitate stomach acid after they eat, or their stomach may hurt so badly they will think they have an ulcer. This is just a sampling of the symptoms that may occur from this disorder.
What is a Hiatal Hernia?
When you swallow, your food passes down a long tube known as the esophagus into the stomach. This tube must pass through a muscle known as the diaphragm, which is located near the bottom of your rib cage. This opening in the diaphragm, which permits the esophagus to pass through, is regulated by a sphincter muscle (or “valve”) which relaxes and opens when we swallow to permit the food to pass through the diaphragm and into the stomach. This sphincter then closes to prevent stomach acid from coming back up into the throat. A hiatal hernia occurs when the top of the stomach rolls or slides up into this opening and becomes stuck there.
Naturally, when part of the stomach is forced into this opening, the sphincter cannot close properly. Thus, stomach acid may travel back up into the esophagus causing burning sensations (heartburn), esophageal spasms, inflammations and ulcers.
The cramped position of the stomach can also stress the vagus nerve, which stimulates the release of hydrochloric acid. This can cause both over and under secretion of hydrochloric acid and stomach enzymes. It may also affect the sphincter or valve at the bottom of the stomach so that digestive secretions “leak” out of the stomach and are lost before they have completed their job.
The hiatal hernia will also interfere with the movement of the diaphragm muscle. This muscle normally pulls downward to expand the chest capacity and inflate the lungs. Since the hiatal hernia interferes with this movement, the person may be restricted to shallow breathing, or will resort to using the chest and shoulders to expand the lung capacity and take a deep breath.
The esophagus may also “kink” in the throat, which will irritate the thyroid gland and may cause some difficulty in swallowing. Often persons with hiatal hernias will have difficulty in swallowing capsules or tablets as they get the sensation that they are “sticking” in their throat.
The irritation on the vagus nerve can cause reflex irritations throughout the body. The vagus nerve comes from the medulla and goes to the heart, esophagus, lungs, stomach, small intestines, liver, gall bladder, pancreas and colon. It also has links to the kidney, bladder, and external genitalia. Thus, a hiatal hernia may start imbalances in the system such as decreased stomach acid and pH imbalance in the intestines and elsewhere.
If a person develops poor stomach digestion due to a lack of hydrochloric acid, they will have difficulty digesting and assimilating protein and most minerals. It will also contribute to food putrefaction in the intestines, causing greater toxicity in the body. This lack of nutrition and toxic condition may contribute towards food allergies, constipation, anemia and immune and glandular system weaknesses.
Two other problems that a hiatal hernia may contribute to are asthma and heart disease. Since the hernia reduces the lung capacity by interfering with natural breathing, it could be a factor in asthma. The hernia may also put pressure on the heart. Gas in the intestines may put pressure on the hernia and push it against the bottom of the heart, which may be one way in which a heart attack can be triggered. None of this spells immediate fatality, but it does point to a major contributing factor in degenerative illness.
The causes of a hiatal hernia are speculative and unique to each individual. However, there are a number causes. First of all there may be a mechanical cause. Improper lifting, hard coughing bouts heavy lifting, sharp blows to the abdomen (the kind that “knock the wind out of you”), tight clothing and poor posture may contribute to the development of this problem. Improper lifting may be the biggest mechanical cause of this disorder. If the air is not expelled out of a person’s lungs while lifting, it will force the stomach into the esophagus.
Secondly, there are dietary causes. Hiatal hernia just about always accompanies a swollen ileocecal valve. The ileocecal valve is the valve between the small and large intestines which permits material to enter the colon from the large intestine, but prevents material in the colon from moving back into the small intestine. When this valve becomes swollen and irritated it cannot close properly. This allows material from the colon to leak back into the small intestine. This is analogous your sewer backing up into your kitchen. This creates gas and indigestion, which puts pressure on the stomach and presses it tighter against the diaphragm.
The relationship between the ileocecal valve and the hiatal hernia is a chicken/egg situation … it is hard to know which comes first. However, it is clear that the ileocecal problem aggravates the hernia. Hence, the things which irritate that valve may be causal factors. These are the basic causes of digestive problems: poor food combining, overeating, drinking with meals, overeating and eating when upset.
Lastly, there are emotional causes. According to one applied kinesiologist text a hiatal hernia comes from repressed anger. A person “swallows their anger” and “can’t stomach it.” When you get angry, you suck your breath upward. If you fail to release this anger, your stomach stays up. I have observed that most of the people with severe hiatal hernias have a great deal of emotional stress and hold a lot of it inside.
The easiest way to tell if you or someone you know has a hiatal hernia is to place your fingers on the solar Plexus, just below the breastbone. Then take a deep breath. You should feel the solar plexus expand and move outward. If there is no movement at the solar plexus and you have to lift your chest and shoulders to take a deep breath, then you probably have a hiatal hernia. You should be able to take a deep abdominal breath without lifting your shoulders.
There are other, more complicated, methods of determining if you have a hiatal hernia, such as muscle testing, but this is a fairly simple and reliable method.
Since a hiatal hernia is primarily a mechanical problem, the easiest and best way to correct it is mechanically. Medical doctors have attempted surgery to correct this disorder, but the results tend to be poor. Cutting into this area can further weaken it so that the hernia will return in short order. A better method is to manipulate the stomach and bring down the hernia by hand. Unfortunately, you can’t do this to yourself. You will need to find a good chiropractor, applied kinesiologist or massage therapist who understands this problems and knows how to correct it.
If you want to learn how to do this adjustment to others, you will have to find someone who does it and have them show you how since it is impossible to adequately describe the technique(s) in writing. They have to be learned through demonstration and practice. ..
There are some self-help adjustment techniques. They aren’t as effective as having someone else perform the adjustment, but they may help. The best one I’ve tried is to drink a pint of warm water first thing in the morning, then stand on your toes and drop suddenly to your heels several times. The warm water helps to relax the stomach and diaphragm and puts some weight in the stomach. By dropping down suddenly, the weight of the water helps to pull the stomach down. In a mild case, this might be enough to bring the hernia down. In a more severe case it may loosen the stomach and make it easier for someone else to bring it down. It will also help you to keep the stomach down once mechanical corrections have been made.
Until the problem is corrected mechanically, there are some nutritional therapies which may be of help. Immediate, but temporary, relief of pain and discomfort can often be achieved by the use of a mucilaginous herb like slippery elm or comfrey. These herbs absorb the digestive secretions and help to prevent their traveling back up the esophagus and burning it. They also help to prevent irritation of the ileocecal valve. Comfrey can also speed the healing of this problem once mechanical adjustments have been made. Okra pepsin is a good combination for this problem as well.
Marshmallow is also helpful in soothing the mucous membranes for hiatal hernias and other ulcerations in the gastrointestinal system.
A digestive aid will help the person obtain the nutrients they need when the hernia is interfering with digestion.
This may take the form of a hydrochloric acid supplement or a food enzyme tablet, or perhaps an herbal digestive aid such as papaya and peppermint, chamomile tea, safflowers, ginger root and so forth.
Other food or herb products that have been used to help people with hiatal hernias include: raw cabbage juice (where ulcerations have occurred), balm, barley water, brown rice, celery, coriander, gentian, hops, licorice, marshmallow and passion flower.
Dietary modifications may be necessary to relieve the problem and to keep it from reoccurring once it has been corrected. Since the pressure of abdominal gas can push the stomach upward, it would be advisable to avoid gas forming foods like beans. It would also be wise to watch food combinations carefully and to avoid overeating. Dr. Jack Ritchason recommends that people with hiatal hernias avoid eating any heavy meals after 3 pm.
What is a Hiatal Hernia?
A hiatal hernia occurs when the top of the stomach rolls or slides up into the opening in the diaphragm which the esophagus passes through and becomes stuck there.
This condition may create difficulty with digestion (and hence general nutrition and well-being) as well as breathing difficulties, nervous problems, circulatory problems and glandular imbalances. All of the following symptoms have been connected with a hiatal hernia. If you have some of these symptoms especially those marked with an asterisk (*) you may wish to consider being checked for this condition.
*Belching, *Bloating, *Heartburn, *Difficulty digesting meat/high protein foods, Tension or pressure at the solar plexus, Sensitivity at the waist, Intestinal gas, Regurgitation, Hiccups, Lack or limitation of appetite, Nausea, Vomiting, Diarrhea, Constipation, Colic in children, Difficulty in gaining weight or overweight, Ulcers.
BREATHING AND CIRCULATION PROBLEMS
*Difficulty with deep abdominal breathing, *Difficulty in swallowing capsules, *Asthma, *Inability to take a deep breath from diaphragm, Overall fatigue, Tendency to swallow air, Allergies, Dry tickling cough, Full feeling at base of throat, Pain or burning in upper chest, Pressure in the chest, Pain in the left side of chest, Pressure below breastbone, Lung pain, Rapid heartbeat, Rapid rise in blood pressure, Pain in left shoulder, arm or side of neck.
TMJ (Temporo-Mandibular Joint Pain), Bruxism (Grinding teeth in sleep), Joint pain, Localized or overall spinal pain, Headaches.
*Suppression of anger or other emotions, *Living with or having lived with a quick-tempered person, Dizziness, Shakiness, Mental Confusion, Anxiety attacks, Insomnia, Hyperactivity in children.
*Open ileocecal valve, *General weakness, *Difficulty in getting and/or staying healthy, Overactive thyroid, Cravings for sugar or alcohol, Candida Albicans, Menstrual or prostate problems, Urinary difficulties, Hoarseness.
Nature’s Field, Vol.17 No.3, May/June 2001
Steps for Manual Manipulation of a Hiatal Hernia
Laura McCready, N.D.
This procedure can be performed on yourselfafter being shown the technique by your natural health practitioner.
Perform this procedure every morning for at least one month, two months for large or long-term hernias. Steps one and two are optional but should be done for tense individuals or stubborn hernias. This procedure can be performed anytime the stomach seems to be displaced but best results are achieved if this is done with an empty stomach.
- Five minutes before the procedure, take a dropperful (15-20 drops) each of Lobelia Essence (stock # 1765-8) and Stress-J Liquid (stock # 3163-3) in 2 ounces of warm water to relax the diaphragm and vagus nerve.
Magnesium Complex (stock # 1859-8) can also be taken daily to promote muscle relaxation.
- Massage Tei Fu Oil (stock # 1618-7), Lavender Essential Oil or Chamomile Essential Oil into the stomach area before the procedure.
- Lie on your back on a hard flat surface or the floor. Take a deep breath and remember what it feels like. (You should be able to breathe deeper and easier when the procedure is over.)
- Place both hands just beneath the breastbone. Palms are against the body and fingers are touching so that the thumbs meet just below (1″-2″) where the ribs come together.
- Take a deep breath and as you slowly and forcefully exhale, push thumbs inward and downward about two inches with a steady, heavy pressure. Do not lift your hands or release the pressure on your abdomen at the end of the breath.
- Maintaining constant pressure with the thumbs, take another breath and repeat the procedure until you reach the waistline. This will take a total of about 3-5 breaths.
- Hold your left thumb in place and move your right thumb over to shut the ileocecal valve. Using your right thumb this valve is found by locating the front, upper point of the right hip bone and moving the thumb toward the center of the body two inches and then down two inches. (This valve must be closed in order for the gastroesophageal valve to remain closed.)
- As your right thumb applies pressure to the ileocecal valve in an inward and upward direction (toward the stomach) move the left thumb over to assist with the pressure. Hold this pressure for 30 seconds. Release with a slight wiggling, massaging motion.
- Repeat the entire procedure (steps 4-8) three times.
Take a deep breath and see how much better you feel.
- To Avoid pressure on the stomach, DO NOT rise as if you were doing a sit-up. Roll onto your side and push yourself to a sitting position using your arms rather than lifting yourself using your abdominal muscles.
Health Parameters Research site.
Pat Block, N.D., 2000.
Ileocecal Valve Massage
The ileocecal valve is a sphincter (circular muscle) which is found where the small intestine connects to the large intestine. It is located above the appendix in the lower right side of the abdomen. When this valve does not function properly a host of gastrointestinal problems and other problems including heart symptoms and blood pressure problems and even migraines can result. Massaging the valve will encourage proper function.
To locate the valve area (its placement can vary slightly for each person) place your left thumb on your navel, your right thumb on your right hip (the high part of your pelvic bone). Imagine a line connecting those two points and find the middle of that line. Place all your fingers 3 inches below the middle of that line and you should be close to the ileocecal valve. On men’s trousers there is usually a belt loop right over the area. With all your fingers, press in FIRMLY and find the tender spot. Believe me this area will be tender in 90% of Americans.
It will be like finding a golf ball under a pillow – but some of us have more pillow than others so keep palpating to locate the spot. (Palpate means to press in slowly but deeply to feel for hardened or tender areas.) Sometimes it is easier to locate the tender spot while lying down. Using some emollient cream may also enable you to find it more easily. Once you’ve found it, massage it in a circular fashion as you would any cramped muscle. After all, the whole digestive tract from the throat to the rectum is a muscular tube – and any section can cramp, get ‘Charlie horses’, become too weak to function, etc.
Ideally, this massage should be done 3X/day before meals. At the least do it in bed before going to sleep and in the morning before you get out of bed. Some people experience gurgling, flatulence, burping – or other sounds during or after this massage and sometimes a bowel movement will follow. All of these are evidence that this valve needs help. You’ll find that the tenderness will subside after about a week or two of diligent application of this technique and you’ll feel much better and be healthier for it.
And then what?
The same massage should then be applied to the rest of the colon by massaging from the ileocecal valve upward toward the ribs where the ascending colon lies. Then, traverse across the belly above the navel to the opposite rib, then down the left side to wind up on the opposite side of the abdomen from the ileocecal valve. This firm, deep massage encourages proper bowel function. Learn where your tender or hardened areas are and continue this massage daily until these resolve. This whole massage can be done through the clothing but take time to locate the all tender spots. You’ll be healthier for it.
Correcting the Displaced Stomach (Hiatal Hernia)
Why does it happen? The hiatal hernia results from the upward displacement of the stomach and the resultant kinking of the esophagus. This often results in heartburn, acid reflux or the newly coined GERD (Gastro Esophageal Reflux Disease). 50% of the American population over 50 have this condition in varying degrees. Resulting symptoms include belching, hiccups, nausea, bloating, shortness of breath, difficulty swallowing capsules or foods, chest pains, irregular or rapid heart beat – all made worse or precipitated by bending over or lying down.
So one must ask: Why does the stomach decide to climb through the diaphragm and move toward the throat? The answer is: it doesn’t go willingly – it is pushed up there by a digestive tract full of gas caused by fermenting and putrefying toxins. (See website Library info on Digestive Path Hygiene or ask at my office) These gases fill up the intestines like a balloon pushing the stomach up into, and sometimes through the diaphragm (which is a muscle that divides the digestion organs from the heart and lungs). This in turn causes the esophageal tube to bend or kink making swallowing difficult and putting pressure on organs above the diaphragm like the thyroid, heart and lungs.
If the lack of nutrients in the body allows for weak connective and muscular tissue, the diaphragm opening will weaken permitting more of the stomach through the opening. The diaphragm will create a pinching force on the muscles of the stomach causing a lower blood flow and consequent cramping of the upper stomach muscle – just like any muscle cramp in your leg or arm, etc. This displacement also puts pressure on the main artery and vein to the lower part of the body creating poor circulation, increased blood pressure and stress on the heart. This produces pain and all the symptoms listed above. So that is the ‘why’ – now how does one fix it.
In addition to the herbs recommended for this condition, (see Herbal Solutions on my website or ask at my office) the following mechanical fix will bring great relief. First it may be advisable to take the herbs and do the ileocecal valve massage described above for about a week prior to pulling down the stomach. Also it will be more effective if there is no problem with constipation – which obviously will continually act to inhibit the exit of gas producing material. If constipation is a problem, go to Herbal Solutions or ask at my office so you can get that resolved before beginning.
This technique should be done on an empty stomach
– first thing in the morning is best, but doing this before each meal will bring quicker results. After massaging the ileocecal valve and colon area first (see above), palpate the stomach area below the sternum or breastbone to find the hardened and/or tender areas. Now gently try to relax them using a gentle circular massage. Again it is sometimes like feeling for a golf ball through a pillow. Now take a deep breath and exhale slowly.
While exhaling and relaxing the abdomen apply a firm inward and downward (toward the feet) pressure with overlapped thumbs from the base of the sternum down toward the navel. You should move about 2 inches down as you exhale. Hold for thirty seconds. Repeat this 3 times. The whole technique should be repeated daily for at least one month doing it before each meal. This can be done through the clothing. You’ll begin to notice a positive difference not only in the amount of tenderness in the abdomen area but in the over all quality of your life and health.
Those who experience a stiff neck will find their neck has greater freedom of movement without pain. Often it is easier to get someone to do this massage for you. They will be using the pads of their fingers to do the pulling – they also may need to cut and file their fingernails. If you are uncertain that either you or your helper is doing the technique correctly, you can just do the massage part. That is, find and massage any tender spots in the abdominal area. I’ll be happy to show you how to do the technique at our next appointment – just let me know ahead of time so we don’t use up our time on other topics.
Lower Abdominal Pressure(for Frequent Urination esp. at Night)
The same bloating forces that dislocate the stomach upward can also press on the organs in the lower pelvic cavity – the bladder, uterus, lower bowel and rectum. To reposition these organs, the tips of the fingers are placed at the top of the pubic bone. With short quick strokes the hand is moved inward (toward the spine) and upward (toward the head). The hand travels in short steps from the pubic bone to the navel and is best done lying down before sleeping. (This exercise is called ‘scooping up the guts’ – a term which helps visualize what is happening.) Doing this repositioning exercise will also increase bladder volume for those who find themselves waking often at night to urinate. Herbs to rebuild the connective tissue will be useful to support the proper organ position – which helps with proper function! .
Hiatal Hernia by Dr Cliff Fruithandler DC An Overlooked Cause of Disease the great mimicker and some natural treatments to help resolve symptoms located in Margate coconut creek parkland coral springs florida in broward county 33067 33066 33065 33066 33068 33071
Gastroesophageal Reflux Disease
Original Editors – Tessa Puckett from Bellarmine University’s Pathophysiology of Complex Patient Problems project.
Top Contributors – Tessa Puckett, Kim Jackson, Elaine Lonnemann, Bruce Tan and Wendy Walker
Gastroesophageal reflux disease (GERD), sometimes referred to as esophagitis, is a complex disease with serious complications. It results from reflux (backward flow) of the stomach contents into the esophagus and causes trouble symptoms at least two times a week. Reflux of infectious agents, chemical irritants, physical agents, such as radiation and nasogastric intubation can cause GERD and can irritate and inflame the esophagus causing heartburn, belching, sore throat and other symptoms.
Heartburn is not another word for GERD, but is the most common symptom of the condition. GERD is the most common cause of heartburn, but there are other disorders that contribute to heartburn.
Although GERD is common in our society, it is rarely life-threatening, but can severely limit daily activities and productivity. GERD can occur in infants and children. Infants typically grow out of the disease, and children with GERD present the same as adults.
GERD is the most common gastrointestinal diagnosis recorded during visits to outpatient clinics. It is estimated that 14-20% of adults are affected, but the estimates are based on self-reported chronic heartburn. Studies have shown that GERD is clinically silent in 24% of cases in which patients had difficult to control asthma. It can often be seen in:
- Patients with asthma
- Middle aged group (45-54 years old)
- Body Mass Index > 25 with asthma and COPD
Pain in the lower substernal area can arise as a result of relfux or GERD; it is commonly described as “heartburn” or “indigestion”. GERD is also described as gripping, squeezing or burning sensations in the substernal area.
Onset of GERD can occur when lying flat on the back, after meals, or bending forward and is usually worse at night. It is important to note that reflux or GERD is often confused with angina or a heart attack and should be reported to the doctor. GERD is not typically exercise induced and is relieved with antacids; this can help differentiate between angina/heart attack and reflux.
Chest pain referred from the upper gastrointestinal tract can radiate from the chest posteriorly to the upper back or interscapular or subscapular regions from vertebrae T10 – L2.
- Bitter/sour taste in the back of the throat
- Sense of a lump in the throat
- Abdominal bloating/Abdominal discomfort
- Chronic Cough
- Feeling the food is trapped behind the breastbone or in the throat
- Nausea after eating
- Burning sensation that begins at the xiphoid processs and radiates up toward the neck
- Intense sharp pain behind sternum with radiation to the back
Less Common Symptoms:
- Difficulty swallowing (dysphagia)
- Hoarseness or change in voice
- Sore throat
- Ear Ache
Patients with a past medical history of alcoholism, cirrhosis of the liver, peptic ulcers, esophageal varices, esophageal cancer, and long term use of NSAID’s are more likely to have symptoms of GERD and should have diagnostic tests performed to rule out more severe conditions or diagnose GERD. It is typical for patients with GERD to have multiple risk factors. Some of the factors that predispose patients to pathologic reflux are:
- Lower esophageal Sphincter hypotension
- Loss of esophagel peristaltic function
- Abdominal obesity
- Increased compliance of the hiatal canal
- Gastric hypersecretory states
- Delayed gastric emptying
- Hiatal hernia
Medications used to treat symptoms of GERD include: Antacids, Histamine 2 Receptor Blockers, and Proton Pump Inhibitors. Indefinite treatment with proton-pump inhibitors or H2-blockers as needed to maintain symptom control.There are risks associated with long term use of proton-pump inhibitors.
- Neutralizes the acid
- Does not reduce it (same amount of acid is produced)
- Available over the counter, do not require a prescription
- Includes Mylanta, Maalox, Tums, Rolaids
Histamine-2 Receptor Blockers
- Reduce stomach acid produced by the stomach
- Some are sold over the counter
- Over the Counter H2 Blockers: Pepcid, Zantac, Tagamet, and Axid
Proton Pump Inihibitors
- Most potent acid-suppressing agent
- Stops acid from forming, instead of neutralizing it
- Some PPI’s are sold over the counter
- Use caution when used without medial supervision
- PPI’s can mask more serious conditions in the esophagus and stomach
- Over the counter PPI’s: Prilosec (omeprazole) and Zegerid
- PPI’s requiring a prescription: Prevacid, Protonix, Nexium (esomperalzole), and Aciphex
People taking the above listed medications should report to the doctor if they have complaints of headache, constipation, diarrhoea, abdominal pain, or dizziness.
It is essential for the physical therapist to take note of the patient’s medications; listen for complaints of headache, constipation, diarrhoea, abdominal pain and dizziness; and report those findings to the doctor.
Diagnostic Tests/Lab Tests/Lab Values
Diagnostic tests are not typically needed unless the symptoms are severe. Physicians will order diagnostic tests to diagnose GERD or other complications if there are severe symptoms, the symptoms are not relieved with medications or the symptoms returned. Severe symptoms include dysphagia, odynophagia, bleeding, weight loss, anemia, and those at risk for Barrett’s esophagus. Commonly used diagnostic tests used to diagnose GERD are discussed below.
A procedure where a small camera is placed at the end of flexible tube; the tube is inserted into the mouth and down the throat and examines the lining of the esophagus, stomach and upper duodenum
This is a special type of imaging that requires the patient to drink barium before undergoing an x-ray. This produces clear images of the upper digestive tract.
Continuous Esophageal pH Monitoring
This procedure involves a thin tube being inserted into the esophagus, through the mouth, to measure acid levels and the pH
This procedure requires a thin tube to be inserted into the esophagus, through the mouth or nose, to measure the pressure of the esophagus
The lower esophageal sphincter (LES) is a ring of muscle fibers that functions to close the opening between the esophagus and the stomach. When the LES is not functioning properly, the stomach contents (food, liquid, and stomach acid) can move backward into the esophagus causing damage to the esophagus. The backward flow of food from the stomach into the esphophagus is called reflux.
- Lower Esophageal Sphincter (LES) Dysfunction
Some of the medications that can cause GERD or make it worse are:
- Nonsteroidal anti-inflammatory drugs (NSAID’s) – Advil (ibruprofen), Motrin, Aleve
- Anticholinergics – Bentyl
- Beta Blockers – Toprol XL
- Bronchodilators – Advair
- Calcium Channel Blockers – Norvasc
- Hormone Replacement Therapy – Progesterone
- Sedatives (benzodiazepines) – Valium, Xanax
- Tricyclic Antidepressants: Doxepin
Untreated ulcers can cause biomechanical changes in muscular contractions and spinal movement. Patient may present with musculoskeletal deficits or dysfunctions because of the untreated ulcer. It is important for the physical therapist to take a good medical history to reveal actual cause of musculoskeletal dysfunction. Patients may think that heartburn while lying flat, difficulty swallowing, or chronic cough is unrelated to their recent onset of midscapular pain or thoracic back pain; thus, it is imperative to ask the patient if they have had any symptoms of GERD and if they are being treated by a medical doctor for the diagnosis.
GERD can cause irreversible dental erosion of the posterior surface of the teeth. Possible symptoms associated with dental erosion included vomiting, experiencing sour taste, belching, heartburn, stomach ache and pain on awakening. Oral Symptoms include: burning mouth syndrome, tooth sensitivity, loss of the vertical dimension of cculsion and aesthetic disfigurement.
Gastric acid in the airways can cause bronchoconstriction which increases bronchial activity. Acid in the esophagus releases substance P and neurokinin A in the bronchial mucosa causing a neuroinflammatory reflex mechanism and airway edema. An increase in asthma severity is caused from an increase in vagal efferent impulses and the results of acid being in the esophagus and the airways.
GERD is a risk factor for Barrett’s esophagus and is linked to esophageal adenocarcinoma. Barrett’s esophagus is a precancerous condition, in which the normal squamous epithelium is replaced by specialized metaplastic columnar cell-lined eipthelium. Chronic GERD is a major risk for esophageal adenocarcinoma.
If lifestyle changes and medications do not help the symptoms of GERD, the individual may be considered for surgical management.
A surgical intevention, in which the proximal stomach is wrapped around the distal esophagus to create and antireflux barrier and is used as an alternative treatment for chronic GERD when conservative management has not been successful. It was a very common procedure in 1990’s, recently not as common due to poor outcomes and patient dissatisfaction. Some associated risks are:
- Severe dysphagia
- Inability to belch
- Increased flatulence
- Abdominal pain
Physical Therapy Management
Patients with GERD occasionally present to the clinic with atypical head and neck symptoms without complaints of heartburn. It is important for the Physical Therapist to be aware of pain referral patterns for the esophagus. With an atypical presentation, the Physical Therapist may need to ask if the patient has a history of difficulty swallowing, difficulty speaking, chronic dry cough, etc.
There are also those patients who attend physiotherapy for other conditions, but have a history of GERD. In this case the Physical Therapist has to be aware of positioning and education on lifestyle modifications if necessary. When treating a patient with GERD:
- Assist the patient in implementing changes related to the diet and exercise
- Educate and encourage the patient on lifestyle modifications
- Educate on Positioning:
- Supine interventions should be avoided after meal
- Encourage the patient to sleep on the left side
- Right side lying allows the acid to flow into the esophagus more easily
- Head up positions minimize reflux and reduce intraabdominal pressur
The Shaker Head-Lifting Exercise
Research has found that performing the Shaker exercise, developed by Dr.Reza Shaker (a gastroenterologist at the Medical College of Wisconsin), can help improve pharyngeal swallowing and dysphagia. It is designed for patients who do not have cervical disc disease, but have dysphagia. The benefits of this technique are:
- Used to strengthen the muscles of the Upper Esophageal Sphincter (UES)
- Used with dysphagia, hiatal hernia, and GERD
- Helps restore normal swallowing
- Helps keep stomach contents from being aspirated into the lungs
How to Perform the Technique
The patient should lie in the supine position on firm, flat surface, without a pillow and arms resting by their sides. They should be instructed to breathe slow and steady throughout the exercise.
- Lift Head (to look at the toes) and Hold
- Lift head to look at toes
- Shoulders should be kept flat on the surface it is only the head that lifts up.
- Hold for 1 minute then the head returns to the starting position.
- Repeat 2 more times, relaxing for 1 minute between each repetition.
- Head Lift and Lower
- Lift head up to look toward the chin and then put return to the start position. (It resembles a sit up but with the head).
- Repeat 30 times.
Changing eating habits and lifestyle along with avoiding foods that may trigger symptoms can help decrease the symptoms of GERD.
There are several foods and beverages that are linked to causing symptoms of GERD (i.e. heartburn) and linked to making the symptoms worse. Physicians suggest people with GERD should avoid these foods along with other foods or activities that have been linked to causing symptoms in the specific individual. Foods and beverages known to cause an increase in symptoms:
- Carbonated beverages
- Citrus fruits and beverages
- Tomatoes and tomato sauce
- Spicy or fatty foods
- Full-fat dairy products
- Peppermint flavors and tobacco can decrease saliva production. Greater saliva production helps soothe the esophagus by washing the stomach contents back down to the stomach.
- Do not smoke
- Do not lie down 2-3 hours after a meal, especially lying flat
- Avoid clothes or belts that fit tightly around the bra line or waist
- Avoid bending over or exercising immediately after a meal
- Eat smaller meals
- Reduce stress
- Elevate the head of the bed about 6 inches with a wedge or by tilting the entire bed, do not use extra pillows to raise your head
- Weight loss may help decrease symptoms, if the individual is overweight.
- Chewing sugar less gum after meals can help promote saliva production and neutralize acid
- Keep a food diary to record foods that trigger GERD and avoid those foods
- Coronary artery disease
- Gallbladder disease
- Gastric or esophageal cancer
- Peptic ulcer disease
- Esophageal motility disorders
- Eosinophilic, infectious, or pill esophagitis
Case Reports/ Case Studies
- Chronic gastroesophageal reflux disease and its effect on laryngeal visualization and intubation: a case report.
- A Randomized Study Comparing the Shaker Exercise with Traditional Therapy: A Preliminary Study
- Dental erosion caused by silent gastroesophageal reflux disease